Prometheus Laboratories Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

05D0917432 Issued in CA

Legal business name

PROMETHEUS LABORATORIES INC.

Practice address

9410 Carroll Park Dr
San Diego, CA 92121-5201

Phone

(858) 824-0895

Fax

(858) 824-0896

NPI assigned

Mar 2, 2007

Last updated

Jun 21, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Patricia Vasquez

Title

SVP, Commercial and Corp. Developme

Phone

(858) 587-4128

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Cedars-Sinai Medical Center

  • General Acute Care Hospital
  • West Hollywood, CA
  • NPI 1891940326

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew Jerome McGinniss, PHD FACMG

  • Ph.D. Medical Genetics
  • San Diego, CA
  • NPI 1023214319
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687305600000",
    "number": "1073642641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9410 CARROLL PARK DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921215201",
            "telephone_number": "858-824-0895",
            "fax_number": "858-824-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9410 CARROLL PARK DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921215201",
            "telephone_number": "858-824-0895",
            "fax_number": "858-824-0896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMETHEUS LABORATORIES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A",
        "authorized_official_last_name": "VASQUEZ",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "SVP, COMMERCIAL AND CORP. DEVELOPME",
        "authorized_official_telephone_number": "858-587-4128"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "05D0917432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB17432F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "162505709",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ59192Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prolific Healthcare Services
• Proline Med Supply LLC
• Promax Hospice Group
• Promedica Medical Supply Inc
• Katherine Emily Promer, MD
• Promises2Kids Foundation
• Prompt Transportation, LLC
• Yuliya Eduardovna Proosaselts, M.D.
• Shea Prophet
• Christopher Mancha Propps

• Clinical Medical Laboratory in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.